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Rhinoplasty Bizrah: ALAR WEDGE EXCISION

March 27, 2017 by basharbizrah0

History:
Robert F. Weir first described alar reduction in 1892. He used an incision along the alar insertion curve. Then, Jack Joseph described his incision that transverses the nasal wall leaving a visible scar. Gustave Aufricht (a student of Joseph) in 1943, described what we use today, as a modified Weir excision. Aufricht stated that ‘nothing causes such an obvious discrepancy in harmony after rhinoplasty as oversized nostrils’.

Indications:

  1. To reduce flare of the rim.
  2. To reduce a wide nostril floor.
  3. To reduce both flaring and wide floor.

Aetiologies:

  1. Alar rim flare is seen in Blacks, Asians, Indians and even white races. It may be associated with wide tip. (Figs. 10 – 6 to 9)
  2. The flaring of the rim may result during operations due to loss of tip support, particularly when the simple technique of transcartilagenous cephalic trimming of the alar rim is applied without alar delivery and without the use of columellar and tip grafts. Some authors reported performing alar reduction in 75% or 90% of their primary rhinoplasties (Millard, Beck). The author of this book only performs the modified Weir incision in 20% of his rhinoplasties, because he routinely uses the technique of new dome creation, suture fixation, scoring, columellar strut and tip grafts unit. These manoeuvres provide excellent tip projection and support and stretch the nostril walls, preventing alar flaring. They not only prevent alar flaring intraoperatively, but also stretch and narrow the nares in patients with preoperative flaring, as the nostrils become more vertical, so a planned preoperative nares narrowing may not be needed by the end of the operation.

Surgical Techniques :

  1. Principles:
    1. Modified Weir excision should be the last step of the septorhinoplasty procedure.
    2. Modified Weir excision should be made in natural creases.
    3. Vestibular skin should be preserved to avoid notching.
    4. The ideal alar floor width is aimed to be approximately equal to the intercanthal distance.

Fig. 10 – 1. Reduction of alar flare.

Fig. 10 – 2. Reduction of the floor width.

Fig. 10 – 3. The first and second incisions extend laterally into the nasolabial groove.
Fig. 10 – 4. The infratip lobule base is about 75% of the nasal base (N.B.) width (Powell and Humphrey’s).
Fig. 10 – 5. An elliptical excision used for reduction of bulky nasolabial junction in the presence of normal size nostrils.
  1. The infratip lobule base is about 75% of the nasal base width and its length is one third of the columella (Powell and Humphrey’s). (Fig. 10 – 4)

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